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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197609011
Report Date:
02/25/2025
Date Signed:
02/25/2025 01:52:49 PM
Document Has Been Signed on
02/25/2025 01:52 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
STRAWBERRY COTTAGE
FACILITY NUMBER:
197609011
ADMINISTRATOR/
DIRECTOR:
GORY, MONICA
FACILITY TYPE:
740
ADDRESS:
43732 SENTRY LANE
TELEPHONE:
(661) 266-7995
CITY:
LANCASTER
STATE:
CA
ZIP CODE:
93536
CAPACITY:
6
CENSUS:
5
DATE:
02/25/2025
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
09:42 AM
MET WITH:
Monica Gory/Administrator
TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Evelin Rios made an unannounced case management- annual continuation to continue an Annual Required Visit that was started on 9/10/2024. LPA was granted entry by staff and met with the administrator shortly after. LPA explained the reason for this visit.
From 10:26 a.m. to 12:54 p.m. LPA continued with a review of resident and staff files.
From 1:27 p.m. to 1:50 p.m. LPA reviewed medication and medication documentation.
No deficiencies cited during this visit.
Exit Interview conducted. Copy of report provided.
SUPERVISORS NAME
:
Eva Miller
LICENSING EVALUATOR NAME
:
Evelin Rios
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/25/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
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